title: The progressivity of health-care financing in Kenya.
abstract: BACKGROUND
  Health-care financing should be equitable. In many developing countries such as Kenya, changes to health-care financing systems are being implemented as a means of providing equitable access to health care with the aim of attaining universal coverage. Vertical equity means that people of dissimilar ability to pay make dissimilar levels of contribution to the health-care financing system. Vertical equity can be analysed by measuring progressivity.
  
  
  OBJECTIVE
  The aim of this study was to analyse progressivity by measuring deviations from proportionality in the relationship between sources of health-care financing and ability to pay using Kakwani indices applied to data from the Kenya Household Health Utilisation and Expenditure Survey 2007.
  
  
  METHODS
  Concentration indices and Kakwani indices were obtained for the sources of health-care financing: direct and indirect taxes, out of pocket (OOP) payments, private insurance contributions and contributions to the National Hospital Insurance Fund. The bootstrap method was used to analyse the sensitivity of the Kakwani index to changes in the equivalence scale or the use of an alternative measure of ability to pay.
  
  
  RESULTS
  The overall health-care financing system was regressive. Out of pocket payments were regressive with all other payments being proportional. Direct taxes, indirect taxes and private insurance premiums were sensitive to the use of income as an alternative measure of ability to pay. However, the overall finding of a regressive health-care system remained.
  
  
  CONCLUSIONS
  Reforms to the Kenyan health-care financing system are required to reduce dependence on out of pocket payments. The bootstrap method can be used in determining the sensitivity of the Kakwani index to various assumptions made in the analysis. Further analyses are required to determine the equity of health-care utilization and the effect of proposed reforms on overall equity of the Kenyan health-care system.
authors.affiliation: Institute of Health & Wellbeing, 1 Lilybank Gardens, University of Glasgow, G12 8RZ, UK kennethmunge@gmail.com.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Munge
authors.affiliation: Institute of Health & Wellbeing, 1 Lilybank Gardens, University of Glasgow, G12 8RZ, UK.
authors.forename: Andrew Harvey
authors.initials: AH
authors.lastname: Briggs
mesh_terms: D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration; D005191:Family Characteristics; D005251:Fees, Medical; D005382:Financing, Personal; D061889:Healthcare Financing; D006801:Humans; D007630:Kenya; D015233:Models, Statistical; D011795:Surveys and Questionnaires
keywords: Kenya; bootstrap method; health-care financing; progressivity; vertical equity